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Patient Collaboration and Person Centeredness in Forensic Psychiatric Care: An Ethical Map

Conference contribution
Authors Christian Munthe
Published in 35th International Congress on Law and Mental Health, July 9-14, 2017, Prague. Abstracts of the XXX Vth International Congress on Law and Mental Health / David N. Weisstub Editor
Publication year 2017
Published at Centre for Ethics, Law, and Mental Health
Department of Philosophy, Linguistics and Theory of Science
Language en
Links ialmh.org/wp-content/uploads/2017/0...
https://gup-server.ub.gu.se/v1/asse...
Keywords Person centred care, patient centred care, forensic psychiatry, mental health, bioethics, philosophy
Subject categories Ethics, Practical philosophy, Nursing, Psychiatry, Forensic Science, Medical Ethics, Health Care Service and Management, Health Policy and Services and Health Economy

Abstract

There is increasing interest in applying ideas from person centred care (PCC) in forensic psychiatry, including increased room for patients to collaborate in the care design. However, standard ethical assumptions in PCC about capacities of patients, as well as a traditional health care ethical context, departs significantly from the forensic psychiatric situation. Forensic psychiatric care is beset with restrictions of personal freedom and motivated partly by patients' incapacity to take responsibility brought by mental ill-health, usually within limits from criminal law, public safety and court orders. The care is supposed to change patients to become more autonomous and responsible in order for the restrictions on freedom to be justifiably relaxed or removed. Doing so may involve some room for independent decision-making by patients, using their responsibility capacities, but PCC opens up for much more far-reaching empowerment of patients, e.g., regarding the goals of care and the acceptance of applied methods. Therefore, there is a manifold increase of the ethical complexity creating tensions for PCC already in standard health care. This presentation provides a map of these ethical complexities, focusing especially on the issue of how the central notions of patient empowerment and shared decision-making should imply within forensic psychiatric care.

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